BACKGROUND:
- Obesity, with its associated comorbidities, is set to become a major risk factor for
cardiovascular disease in the 21st century. To this day, diet and medical therapy have
proven only limited efficacy and bariatric surgery remains the last resort for many
severely obese patients who wish to lose weight, modify their cardiovascular risk
factors and ultimately modify their long-term prognosis. However, bariatric surgery
remains associated with significant procedural morbidity and many patients are not
eligible for such a surgery procedure as the risk-benefit ratio of bariatric surgery in
severe obese patients with coronary artery disease is not yet well known.
- Recently, percutaneous left gastric artery embolization has been reported as a promising
technique leading to a body weight loss that is equivalent to bariatric surgery.
- In the context of an endovascular procedure in obese patients, vascular access is a
major concern. Transradial access (or radial artery approach) has been consistently
associated with significant reductions in access-site related vascular complications and
peri-procedural bleeding compared to the standard transfemoral access (or femoral artery
approach). This is particularly evident in patients with severe obesity.
- Visceral arteries most often have an acute angulation with the aorta which makes them
more easily cannulated from above (transradial access) compared to below (transfemoral
access). Preliminary experience has shown that cannulation of the celiac artery is
feasible from transfemoral and transradial access, the latter being associated with
shorter procedural time and less contrast agent use. To date, several pilot studies have
reported successful percutaneous embolization of the left gastric artery with
biodegradable microspheres. This appears to be a promising technique to reduce weight in
severely obese patients.
- Prior to launching a randomized trial, further study is warranted regarding the
feasibility and safety aspects of transradial angiography of the celiac artery.

Introduction: It is known that weight loss results in decreased Resting Energy Expenditure
(REE), due to a decrease in lean body mass (LBM), but also due to metabolic adaptation,
resulting in a higher energy efficiency, responsible for weight regain. Powerlifting athletes
submit themselves to caloric restriction before a competition to reach their desired weight
category. After cessation of the restrictive diet body mass will quickly return to pre-diet
values with a disproportionate gain of fat mass. To avoid fat gain 'reversed dieting' has
become popular among athletes. This involves increasing caloric intake in a stepwise fashion
with the assumption that the small increases in caloric intake might help to restore energy
expenditure toward pre-dieting levels and decrease the chance of increasing fat mass. While
anecdotal reports of successful reverse dieting are available, research is needed to evaluate
its true efficacy. In addition, if the method would work in non-athletes this could be an
important change in the risk of weight regain after a weight loss diet. .
Aim: To test the effects of the reverse dieting protocol in the prevention of metabolic
adaptation following a period of caloric restriction in weight training athletes. .
Methods: A convenience sample of 3 powerlifters is used in this study. They are submitted to
a 750kcal/day caloric deficit with a protein intake set at 2x bodyweight (kg) and 30%en from
fat for 6 weeks, adjusted weekly. The reverse dieting protocol adds 100kcal during week 1-4
and 150kcal during week 5-8. REE is measured bi-weekly and body composition at day 1 of
caloric restriction and day 1 and day 56 of reverse dieting. Exercise is kept constant during
the entire period. .

In this study the investigators wish to investigate whether a short duration High-intensity
Interval Training(HIT) is superior to a moderate activity training modus with regards to
improving weight-loss, Blood pressure and sleep quality in severely obese children and
adolescents also receiving a multidisciplinary treatment regime.

The purpose of this study is to evaluate whether an intervention targeting healthy habit
development reduces the risk and prevalence of obesity in low-income mothers and children.
The study intends to evaluate whether the intervention, delivered in the context of home
visitation services for low-income families, reduces weight gain and risk factors associated
with parent and childhood obesity compared to those receiving standard home visitation
services.

The Wellness Champions for Change (WCC) study aims to reduce pediatric obesity among students
who attend schools in Maryland by training teacher and student-led wellness teams to increase
opportunities for physical activity and healthy eating at school.
The study uses a cluster randomized design to allocate 6 schools (3 elementary, 3 middle) in
5 school systems to one of 3 arms: "A" (teacher and student training), "B" (teacher training
only), and "C") (delayed teacher training/control). Approximately 36 3rd/6th graders and
their caregivers ("evaluation cohort"), 15 4th/7th graders ("student leaders"), and 20
teachers from each school will be recruited in the spring before the intervention. All
schools will identify a teacher "Wellness Champion" who will coordinate intervention
activities. In "A" and "B" schools, wellness champions will attend a training to learn how to
build a wellness team and create more opportunities for students to make healthy choices. In
"A" schools, student leaders ("Student Wellness Champions") will meet weekly during lunch
with a health educator to receive training as peer leaders and help the Wellness Champion
with wellness initiatives. Student leaders in "B" and "C" schools will receive a monthly
general Adolescent Health Curriculum. To assess the impact of the teacher and student-led
interventions, the evaluation cohort will be followed for 2.5 years, with measures including:
anthropometry (height/weight), 7-day accelerometry (physical activity), and validated
questionnaires to assess healthy eating. Student leaders will be followed for 1.5 years to
assess the impact of their participation, with measures including: anthropometry, 7-day
accelerometry, validated questionnaires to assess healthy eating, and validated
questionnaires and focus groups to assess leadership/advocacy skills. Teachers will complete
validated questionnaires to investigate their perceptions of the school environment,
classroom practices, and role modeling skills. Prior to data collection and analysis,
participants will be assigned an identification number, and all documents linking participant
information to identification numbers will be locked/ password-protected.

Research purpose: The purpose of this pilot study is to assess obese clients for two
phenotypes, those testing positive and those testing negative for Food Addiction (FA) (Yale
Food Addiction Scale, YFAS) and determining the efficacy of four treatments: usual care (IC,
dietary and physical activity instruction), individual motivational interviewing alone (MI),
individual MI with pharmacotherapy (MI+P) for improving outcome measures within each
phenotype, and pharmacological therapy (P).
Background/significance: Obesity has long been an epidemic in the U.S. and other countries.
Numerous approaches have been tried to address obesity with limited success. The YFAS is a
relatively new, validated instrument that can help researchers and practitioners assess obese
clients for food addiction. Meeting the YFAS diagnosis criteria for FA suggests the need for
a stronger intervention with close monitoring to assist these clients in self-management of
their eating and physical activity behaviors.
Proposed methods/approach: The investigators propose assessing obese clients with the YFAS as
part of their intake once they are referred to the Healthy Behaviors Clinic by Regional West
physicians/practitioners. A nurse researcher with expertise in MI and a nurse practitioner
will perform intake assessments, obtain consent and randomly assign participants in each
phenotype (positive or negative for FA) to one of three treatment groups (usual care,
individual MI alone, and individual MI with pharmacotherapy). Interventions will occur over 6
months. A clinical psychologist with expertise in the YFAS (University of Michigan) will
serve as a consultant on this project and a registered dietitian (University of
NebraskaLincoln) will serve as a co-investigator.
Expected outcomes: The investigators expect that MI and MI+P and P will be more effective in
improving outcome measures than IC. We also expect that response to the treatments will
differ between the two obesity phenotypes (those testing positive and those testing negative
for FA).

An online web-based cross-sectional survey in which participants will complete a distinct
questionnaire for patients with hemophilia and obesity (PwHO) and/or their
carers/spouses/partners, or a distinct questionnaire for healthcare professionals. Each
questionnaire consists of more than 100 items including pre-coded (multiple choice)
closed-ended questions, yes/no questions and rating scales. It is estimated that this one-off
survey will take approximately 45-60 minutes to complete.
As a cross-sectional study, there will be no treatment of patients.

Aging is associated with significant declines in muscle mass, strength, and physical
performance, all of which lead to disability, loss of independence, and adverse clinical
outcomes. Obesity exacerbates these age-related declines in function and is associated with
poorer clinical outcomes and quality of life. Weight loss can also worsen age-related loss of
muscle mass and decrease bone mineral density. The overall goals of this study are to
determine if the short-term functional benefits of intentional weight loss are sustained
long-term, and to examine the long-term benefits and risks of weight loss.

The present study aims to explore the impact of combining laparoscopic greater curvature
plication with a single gastro-ileal anastomosis in the same manner of single anastomosis
sleeve ileal bypass on weight loss and postoperative complications. The objective of this
combined procedure is to reduce the high intraluminal pressure that results after
laparoscopic greater curvature plication owing to reduced intraluminal space which can lead
to suture line leakage, vomiting, and gastroesophageal reflux disease. Another objective is
to add a malabsorptive element to the restrictive effect of laparoscopic greater curvature
plication and to induce early satiety in patients by distention of the distal bowel with
nutrients immediately after meals, similar to the way that single anastomosis sleeve ileal
bypass works.

General anaesthesia involves giving patients anaesthetic and muscle relaxant medications to
allow transition to sleep and airway relaxation to permit laryngoscopy, respectively. During
laryngoscopy, a breathing tube is placed to 'secure' the airway. There is therefore a length
of time from administration of these medications to when the breathing tube is placed, when
the patient is not breathing and the airway is not secured. This time is known as apnoea
time. In a patient who is not breathing, blood oxygen levels fall to dangerously-low levels,
within 1-2 minutes. In order to prevent this, patients breathe 100% oxygen before induction
of anaesthesia as part of a process known as pre-oxygenation. There are different ways of
delivering pre-oxygenation, but the common aim is to increase the oxygen reservoir within the
lungs to give the anaesthetist more time to place the breathing tube. With good
pre-oxygenation, apnoea times of up to 7 minutes are possible.
Apnoea time is a potentially hazardous period during induction of anaesthesia and it is
particularly so in patients with severe obesity. On the one hand, obesity makes the upper
airway anatomy difficult, and on the other hand, lung collapse (atelectasis) caused by
abdominal contents compressing the base of the lungs reduces the amount of oxygen available
within the lungs. Apnoea time can be as short of 30 seconds. Identifying the most effective
method of pre-oxygenating bariatric patients can therefore significantly improve the safety
of delivering general anaesthesia to these patients.
The purpose of the study is to compare effectiveness of different methods of achieving
pre-oxygenation in bariatric patients. The investigators intend to compare facemask
pre-oxygenation with a high-flow humidified nasal oxygen.
The primary outcome measure of interest is time to desaturation to 92% or 18 minutes of
apnoea.

Interventional studies are often prospective and are specifically tailored to evaluate direct impacts of treatment or preventive measures on disease.

Observational studies are often retrospective and are used to assess potential causation in exposure-outcome relationships and therefore influence preventive methods.

Expanded access is a means by which manufacturers make investigational new drugs available, under certain circumstances, to treat a patient(s) with a serious disease or condition who cannot participate in a controlled clinical trial.

Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question.

Phase 1: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.

Phase 2: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.

Phase 3: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.

Phase 4: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

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